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Diabetes Mellitus and Breast Cancer Outcomes: A Systematic Review and Meta-Analysis

医学 乳腺癌 糖尿病 荟萃分析 危险系数 内科学 癌症 肿瘤科 人口 死因 梅德林 疾病 置信区间 内分泌学 法学 环境卫生 政治学
作者
Kimberly S. Peairs,Bethany B Barone,Claire Snyder,Hsin-Chieh Yeh,Kelly B. Stein,Rachel Derr,Frederick L. Brancati,Antonio C. Wolff
出处
期刊:Journal of Clinical Oncology [Lippincott Williams & Wilkins]
卷期号:29 (1): 40-46 被引量:378
标识
DOI:10.1200/jco.2009.27.3011
摘要

Purpose The goal of this study was to perform a systematic review and meta-analysis to examine the effect of pre-existing diabetes on breast cancer–related outcomes. Methods We searched EMBASE and MEDLINE databases from inception through July 1, 2009, using search terms related to diabetes mellitus, cancer, and prognostic outcome. Studies were included if they reported a prognostic outcome by diabetes status, evaluated a cancer population, and contained original data published in the English language. We performed a meta-analysis of pre-existing diabetes and its effect on all-cause mortality in patients with breast cancer and qualitatively summarized other prognostic outcomes. Results Of 8,828 titles identified, eight articles met inclusion/exclusion criteria and described outcomes in patients with breast cancer and diabetes. Pre-existing diabetes was significantly associated with all-cause mortality in six of seven studies. In a meta-analysis, patients with breast cancer and diabetes had a significantly higher all-cause mortality risk (pooled hazard ratio [HR], 1.49; 95% CI, 1.35 to 1.65) compared with their nondiabetic counterparts. Three of four studies found pre-existing diabetes to be associated with more advanced stage at presentation. Diabetes was also associated with altered regimens for breast cancer treatment and increased toxicity from chemotherapy. Conclusion Compared with their nondiabetic counterparts, patients with breast cancer and pre-existing diabetes have a greater risk of death and tend to present at later stages and receive altered treatment regimens. Studies are needed to investigate pathophysiologic interactions between diabetes and breast cancer and determine whether improvements in diabetes care can reduce mortality in patients with breast cancer.
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